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Internalizing Symptoms: Effects of a Preventive Intervention on Developmental Pathways from Early Adolescence to Young Adulthood

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Abstract

This study examined the mediated and moderated effects of a universal family-focused preventive intervention, delivered during young adolescence, on internalizing symptoms assessed in young adulthood. Sixth grade students (N = 446; 52% female; 98% White) and their families from 22 rural Midwestern school districts were randomly assigned to the experimental conditions in 1993. Self-report questionnaires were administered at seven time points (pre-test to young adulthood—age 21) to those receiving the Iowa Strengthening Families Program (ISFP) and to the control group. Results showed that growth factors of adolescent internalizing symptoms (grades 6–12) were predicted by ISFP condition and risk status (defined as early substance initiation). Moderation of the condition effect by risk status was found, with higher-risk adolescents benefitting more from the ISFP. Results also supported the hypothesis that the ISFP’s effect on internalizing symptoms in young adulthood was mediated through growth factors of adolescents’ internalizing symptoms; risk moderation, however, was only marginally significant in young adulthood. The relative reduction rate on clinical or subclinical levels of young adult internalizing symptoms was 28%, indicating that for every 100 young adults displaying clinical or subclinical levels of internalizing symptoms from school districts not offering an intervention, there could be as few as 72 displaying those levels of symptoms in school districts that offered middle school prevention programming. These findings highlight how the positive effects of family-focused universal interventions can extend to non-targeted outcomes and the related potential public-health impact of scaling up these interventions.

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Notes

  1. In this case, a 4-group model (N = 440) had 114 estimated parameters. Guidelines suggest a ratio of at least 5:1 for accurate parameter estimates, which would indicate a minimal sample size of around 570. (The ns for higher-risk groups were 43 and 48.) With a 4-group unconstrained model, the fit was not acceptable, CFI=.841, and Heywood cases (negative error variances) were found in two of the subgroups (higher- and lower-risk control groups). These problems in modeling were not found using the group code approach, supporting our choice.

  2. Nested model testing was conducted to determine the best fitting model(s) with the Yuan-Bentler T2* test. The model with only the control variables (baseline internalizing and gender) as predictors of the intercept, slope, and quadratic factors and young adult internalizing symptoms was compared with (a) the model that included intervention condition and risk predicting the intercept, slope, and quadratic factors, and young adult internalizing symptoms (Δ\( \chi_{(13)}^{2} \) = 42.53, P < .001); (b) the model described in (a) was compared with the model that added the interaction term predicting the same outcomes, (Δ\( \chi_{(18)}^{2} \) = 43.64, P < .001); and (c) the model described in (b) was compared with the model that added mediation of condition, risk, and the interaction by the intercept, slope, and quadratic factors, and eliminated the direct paths to young adult internalizing symptoms for condition, risk, and the interaction (Δ\( \chi_{(2)}^{2} \) = 8.15, P = .02). Including the direct paths, as described in the text, did not improve model fit and the paths were non-significant.

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Acknowledgments

Work on this paper was supported by research grants DA 007029 from the National Institute on Drug Abuse, AA 014702 from the National Institute on Alcohol Abuse and Alcoholism, and MH 49217 from the National Institute of Mental Health. The authors wish to thank the individuals and communities that participated in the study and the many staff members and associates who collected the data and assisted with data management and analyses.

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  1. The Partnerships in Prevention Science Institute, Iowa State University, ISU Research Park, Building 2, Suite 2400, 2625 North Loop Drive, Ames, IA, 50010, USA

    Linda Trudeau, Richard Spoth & Chungyeol Shin

  2. Family and Consumer Sciences, Bradley University, Bradley Hall 05, 1501 W. Bradley Ave., Peoria, IL, 61625, USA

    G. Kevin Randall

  3. Boys Town National Research Institute, 14100 Crawford Street, Boys Town, NE, 68010, USA

    W. Alex Mason

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  1. Linda Trudeau
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Correspondence to Linda Trudeau.

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Trudeau, L., Spoth, R., Randall, G.K. et al. Internalizing Symptoms: Effects of a Preventive Intervention on Developmental Pathways from Early Adolescence to Young Adulthood. J Youth Adolescence 41, 788–801 (2012). https://doi.org/10.1007/s10964-011-9735-6

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